REPUBLIC OF THE PHILIPPINES )

Province of Leyte )
Municipality of Villaba ) S.S.
x-------------------------x

AFFIDAVIT OF LOSS
I, SHELAME M. ALINTON, Filipino, of legal age, single and a resident of Brgy.
Montealegre, Kananga, Leyte, Philippines, after being duly sworn to in accordance with law,
hereby depose and state that:

1. I am a graduating student of the Visayas State University (VSU) – Villaba Campus;

2. On April 19, 2018, I was apprised by the University Registrar of VSU-Villaba Campus
that I lacked Form 138, a required piece of document for graduation;

3. When I tried to look for my Form 138, together with my other important documents, I
realized that said document has been lost as a result of the devastation of Typhoon
Yolanda sometime on November 2013;

4. That despite diligent search and efforts to locate the said Form 138, I could not find it
such that I now believe that it is now lost beyond recovery;

5. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing, to
support my application for graduation with VSU-Villaba Campus and for whatever
legal purpose that this Affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 6th day of August, 2018 at
Villaba, Leyte, Philippines.

______________________
SHELAME M. ALINTON
AFFIANT

SUBSCRIBED AND SWORN to before me, this 6th day of August, 2018, by the Affiant
who is personally known to me (or whom I have identified through competent evidence of identity)
and who exhibited her School Identification Card No. V14-01-0162 issued at Villaba, Leyte,
Philippines.

NOTARY PUBLIC

Doc. No. 524;

Page No. 105;
Book No. XIII;
Series of 2018.